23 / 01 / 2009
NHS West Midlands
Worcestershire Acute Hospitals NHS Trust has two consultant-led maternity units which deal with 1900 and 4000 deliveries respectively. The average caesarean rate is 28%. The scrub role at a caesarean section has, for some years, sat within the remit of midwives and there was a growing need to balance the increasing demands upon maternity services to ensure that midwife time is appropriately utilised by matching the skills with the appropriate level of care to modernise the maternity workforce.
The first cohort achieved competence in April 2006 with roll out to two further pilot sites taking place during 2008.
The programme was developed to address both workforce issues and quality concerns within the two consultant midwifery units in the trust.
The main issues to be addressed were:
- difficulties in recruitment/retention of midwives and theatre staff
- dependence of bank staff and high levels
- high sickness absence
- high infection rates at one site
- unable to provide continuity of care
- lack of structured training and competency checks for healthcare assistants in the Obstetric Theatre
- lack of training assurance/competence associated with the scrub role
- to enable the more technical and specialised tasks to be performed by the midwife especially during the intrapartum period of care.
The Worcestershire Acute Hospitals NHS Trust developed a training programme in obstetrics for Health Care Assistants. The programme at the Alexander Hospital Redditch site consisted of 6 months rotational clinical placements and six months NVQ PCS level 3 plus scrub training to develop the required competency based skills.
More recently, NHS West Midlands and Skills for Heath have supported a regional trainer for 12 months to deliver and assess the transferability of this training and role to 2 other sites within the region. The project is well underway within University Hospital of North Staffordshire and Walsall Manor Hospital NHS Trust who started their training in June 2008 and August 08 respectively.
In April 2006 the first cohort achieved competence at the Redditch site, followed by the second cohort in December 2006. The cohorts achieved the NVQ Perioperative Care Support at level 3 (with the additional 6 scrub units) in October 2006 and June 2007 respectively.
The roll out of the project is well under way with two additional pilot sites testing the transferability from the original site in Redditch.
The initial results have been:
- 75 hours of midwifery time released a week
- greater continuity of care for mothers and newborns
- maternity support worker can progress onto a foundation degree level qualification
Additional learning is expected from the two additional pilots when the benefits realisation is completed at the end of the year.
In order to make the project a success, it is important to recognise that you must involve stakeholders as widely as possible and:
- take a flexible approach and allow for creativity
- be aware that there is always some resistance to implementing change
- champions are key
- allow time for the process to take place
Brenda Smith, Theatre Clinical Skills Regional Trainer